Foster parents needed for babies withdrawing from drugs

By Sharon TirrellDSS

Published: Thursday, July 31, 2014 at 10:00 a.m.

Last Modified: Thursday, July 31, 2014 at 10:02 a.m.

"There is a rising tide of babies born to drug addicted mothers," says Pam Fisette, a social work supervisor at the Henderson County Department of Social Services, "and we desperately need more families willing to care for them. Ten years ago we would take an occasional drug-dependent infant into custody, but in the last 12 months we’ve placed nine in foster homes."

The four Bradley children pose with baby London. From left to right are Zoe, Michael, Malaki and Lauren.

PHOTO PROVIDED

That’s been a problem, according to Fisette, because there are currently only six licensed foster families able to take medically fragile babies.

The same problem is faced by social service departments across the country. According to a national study recently published in the Journal of the American Medical Association, the number of babies born dependent on opiates tripled in the decade, from 2000 to 2010, and the cost of their hospital stays increased five times more than the cost for healthy babies.

There are no national statistics to document the scale of the problem today, but neonatal doctors say it continues to escalate due to the increase in opiate use, including prescription drugs. A recent national study found that 16.2 percent of pregnant teens and 7.4 percent of pregnant women ages 18-25 used illicit drugs during pregnancy. Many women do not understand that painkillers can affect their unborn babies.

Opiates block pain receptors in the brain, and they are habit forming. The earliest use dates back to 6000 BCE with opium. Modern day opiates include morphine, heroin, hydrocodone (in Vicodin and some cough medicines), and oxycodone (in Percoset), which is more powerful than hydrocodone.

Methadone is a synthetic opiate that is easily regulated and controlled. It is used to help heroin addicts wean off heroin. When pregnant women admit to being addicted to heroin or other opiates, they are treated with methadone so they can receive regulated monitored doses instead of sporadic levels of drug use. It can improve infant outcomes and hopefully help the mother wean off opiates by tapering doses.

When the baby of a woman using methadone (or heroin or morphine) is born, the supply of the drug, which crossed the placenta, is suddenly cut off. The baby goes into withdrawal. Symptoms are not unlike those experienced by a heroin addict who goes "cold turkey."

"It used to be said that these babies were born addicted to drugs, but the correct medical term is Neonatal Abstinence Syndrome," explained Fisette. "There is a behavioral component to addiction, and these babies have no choice."

Infants born dependent on methadone or other opiates may have mild or severe withdrawal symptoms depending on the length of time and amount drugs the mother used. Symptoms may appear in the first 24 hours and up to 72 hours after birth. Regardless of the severity of dependence, the majority of babies will suffer some withdrawal, said Dr. Terry Baird, neonatologist at the Cleveland Clinic.

Babies with NAS typically have a small head circumference and low birth weight. They’re often premature. They are irritable and jittery. Their cry is high-pitched. They may sweat and have a fever. They are prone to tremors and seizures. They have eating problems, vomiting and diarrhea. They don’t sleep well. They may have increased muscle tone (stiff limbs). They develop more slowly and are at higher risk for birth defects.

Babies with NAS go to the hospital’s Neonatal Intensive Care Unit after birth. Treatment can last as little as a week or stretch into many months. Mild symptoms may respond to comfort measures such as swaddling and extra sucking. Babies with moderate to severe symptoms generally receive methadone and/or morphine. Sometimes Phenobarbital is added when the baby has seizures.

Doses are tapered off very slowly as the symptoms lessen until a baby is weaned. The babies need a dark, calm environment and need to be held a lot. When the symptoms can be managed at home, babies are discharged from the hospital. A nurse visits regularly to monitor symptoms and progress.

Ideally, according to Fisette, a foster parent for a medically fragile baby would nurture the baby and mentor the biological mother so that she could assume care when she was drug-free. In reality, none of the nine addicted mothers whose children came into custody in Henderson County this year has been able to kick the habit.

"It’s hard to find foster homes for babies in withdrawal because they need so much attention," said Fisette. "Babies with severe symptoms need a stay-at-home caregiver for as much as six months. Foster parents do this work because they love babies and they want to make a difference in a child’s life."

To learn more about becoming a foster parent, call Darlene Stone at 694 6252.

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Sharon Tirrell is president of the Board of Social Services.

Second family

Marilyn Butler never thought she'd have a second family. One of her sons is in the Army and the other in college. She was recovering from a serious medical condition.

She moved to Henderson County to share a home with her friend, Catherine Heath, a nursing home administrator. Catherine had always wanted a baby. Marilyn decided to help her realize her dream by assuming the role of stay-at-home mom. Together they became foster parents.

Three years ago they took responsibility for three-day-old methadone-dependent twins, Jimmy and Charlie. The twins' biological mother had used crack cocaine, heroin and Trazadone during pregnancy.

They had all the symptoms common in babies with severe Neonatal Abstinence Syndrome. Jimmy had breathing problems. He banged his head. He had no control of his tongue muscles for a time, so he required extensive speech and language therapy. Today at 3 he has severe Attention Deficit Hyperactivity Disorder.

"We were concerned that Charlie had cerebral palsy because he couldn't bring his hands together, but with ongoing occupational therapy that has improved." Marilyn said. "Charlie was so over-stimulated that he had to be swaddled for eight months. He still has meltdowns when he's upset; he can't control himself or soothe himself. We have to hold him tightly and soothe him. We have learned to do brushing therapy, which seems to be helping."

The meltdown Marilyn talked about is believed to result from overactive responses of an immature central nervous system. Brushing therapy is a technique created by an occupational therapist to stimulate the brain to develop its ability to process sensory stimuli. That nervous system maturation is necessary for a child to self-regulate behavior.

The therapy involves brushing the arms and legs with a soft brush combined with gentle joint compression. It must be taught by a trained occupational therapist and performed correctly. The technique is often used with children who have severe ADHD and autistic children.

Marilyn and Catherine have taken on a new challenge as foster parents for Rhelin, a baby girl now 4 months old. She was born to a mother who used 25 different kinds of illegal and prescription drugs during pregnancy, according to Marilyn. Rhelin was in the neonatal intensive care unit for six days, where she was given methadone and morphine.

"She remained in the hospital until she was off morphine," said Marilyn. "I went to Mission Hospital every day to hold her. When she was discharged we had a lot of in-home help from Care Partners. A pediatric nurse checks her regularly. She is developmentally delayed; she still doesn't roll over. She wasn't pulling her legs up; she was stiff, so a pediatric physical therapist came out and worked with her on that.

"The most difficult symptom for us is her screaming. A baby with NAS has a cry like no other baby. We had to up her dose of methadone from twice to three times a day for a while."

So intense was Rhelin's crying that Care Partners asked Marilyn to make a five-minute video which may be used for training neonatal medical professionals regarding stepping down methadone dosage.

If you asked Marilyn and Catherine if all their efforts were worth it, you would get an enthusiastic "Yes." Catherine has adopted the twins.

"The boys are so sweet and loving; they give us so much love back," said Marilyn. "Despite their difficulties, they know their ABCs, their primary colors and they can count to 20. That's very rewarding. And Rhelin is one of the prettiest babies I've ever seen. We just love them!"

(Marilyn and Catherine asked that their real names not be used. They would prefer not to have contact with the children's biological parents.)

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